Long-term clinical outcomes after unprotected left main trunk percutaneous revascularization in 279 patients

Walter A. Tan, Hideo Tamai, Seung Jung Park, H. W.Thijs Plokker, Masakiyo Nobuyoshi, Takahiko Suzuki, Antonio Colombo, Carlos Macaya, David R. Holmes, David J. Cohen, Patrick L. Whitlow, Stephen G. Ellis

Research output: Contribution to journalArticlepeer-review

246 Scopus citations


Background - Percutaneous coronary revascularization (PCI) has been increasingly applied to unprotected left main trunk (LMT) lesions, with varied long-term success. This study attempts to define the predictors of outcome in this population. Methods and Results - Two hundred seventy-nine consecutive patients who had LMT PCI at 1 of 25 sites between 1993 and 1998 were studied. Forty-six percent of these patients were deemed inoperable or at high surgical risk. Thirty-eight patients (13.7%) died in hospital, and the rest were followed up for a mean of 19 months. The 1-year incidence was 24.2% for all-cause mortality, 20.2% for cardiac mortality, 9.8% for myocardial infarction, and 9.4% for CABG. Independent correlates of all-cause mortality were left ventricular ejection fraction ≤30%, mitral regurgitation grade 3 or 4, presentation with myocardial infarction and shock, creatinine ≥2.0 mg/dL, and severe lesion calcification. For the 32% of patients <65 years old with left ventricular ejection fraction >30% and without shock, the prevalence of these adverse risk factors was low. No periprocedural deaths were observed in this low-risk subset, and the 1-year mortality was only 3.4%. Conclusions - Patients undergoing unprotected LMT PCI have frequent serious comorbidities and consequently have high event rates. PCI may be an alternative to CABG for a select proportion of elective patients and may also be appropriate for highly symptomatic inoperable patients. Meticulous follow-up of hospital survivors is required because of the rather high mortality during the first few months after treatment.

Original languageEnglish (US)
Pages (from-to)1609-1614
Number of pages6
Issue number14
StatePublished - Oct 2 2001


  • Angioplasty
  • Coronary disease
  • Revascularization
  • Stents

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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